Form No. ......................

DELHI PUBLIC SCHOOL

SUSHANT LOK, GURGAON

Registration Form
Session

PHOTOGRAPH OF PHOTOGRAPH OF PHOTOGRAPH OF

FATHER MOTHER CHILD

Admission No. ................................................

Registration No. .............................................

ISSUE OF REGISTRATION FORM DOES NOT GUARANTEE ADMISSION.

Please register the name of my son/daughter/ward for admission in your school.
Information relating to the child
1. Class to which admission is sought...................................................................................................................
2. Childs Name (Full name in block letters) ........................................................................................................
3. Date of birth (in words and in figures) .................................................................................................................
............................................................................................................................................................................
Age on last birthday .................................Years
Age as on 30th September (year of admission) .................Years ....................... Months ....................... Days
4. Nationality of Child ................................................................ Mother Tongue ..........................................................
Religion .......................................................................... Category ..........................................................................
5. a) Home Town ....................................................................... State ........................................................................
Nearest Railway Station/ Airport .........................................................................................................................
b) Address : (Permanent) .......................................................................................................................................
...................................................................................................................................................................
...................................................................................... Phone No. ...................................................................
c) Address: (Present) .............................................................................................................................................
...................................................................................................................................................................
...................................................................................... Phone No. ...................................................................
6. a) Name of previous school ..................................................................................................................................
b) Class in which s/he was studying in the previous school ..................................................................................
c) Medium of instruction in previous school English Hindi
d) For Class III onwards - Details of grade/marks (%) obtained in the last annual exam

Subject

Marks/
Grade
(Please mention if upgraded as per CCE)
 e) Outstanding achievements in other activities (if any) .......................................................................................
...................................................................................................................................................................
f) Details of disability (if any) ...............................................................................................................................

Information relating to the family

1. Fathers Name (Block Letters) .................................................................................................................................
Academic Qualifications...........................................................................................................................................
Occupation .................................................................... Designation .....................................................................
Name of the Organisation/ Company .....................................................................................(Private/Govt. sector)
Office Address .........................................................................................................................................................
Phone : Office ......................................... Res. .......................................Mobile No. ..............................................
Email id ....................................................................................................................................................................
2. Mothers Name (Block Letters) ................................................................................................................................
Academic Qualification ............................................................................................................................................
Occupation .................................................................... Designation .....................................................................
Name of the Organisation/ Company .....................................................................................(Private/Govt. sector)
Office Address .........................................................................................................................................................
Phone : Office ......................................... Res. .......................................Mobile No. ..............................................
Email id ....................................................................................................................................................................
3. Legal Guardians Name (if applicable) ...................................................................................................................
Academic Qualification ............................................................................................................................................
Occupation ..................................................................... Designation ....................................................................
Name of the Organisation/ Company .....................................................................................(Private/Govt. sector)
Office Address .........................................................................................................................................................
Phone : Office ......................................... Res. .......................................Mobile No. ..............................................
Email id ....................................................................................................................................................................
4. Particulars of Dipsite parents (if applicable) - School ........................................................................................
Year of Passing ............................
5. Particulars of real brothers/sisters studying in Delhi Public Schools
Name of Child Admission No. Class/Section School Branch

6. Kindly study the fee structure carefully and mark the preferred payment option
Annually Quarterly Monthly

Checklist of documents to be submitted ( marks)

i) Attested Municipal Birth Certificate
ii) Copy of last report card for class Prep to II
iii) Copy of report card of last two years (Applicable for class III onwards)
iv) Copy of current years first term report card (if applicable)
v) Certificate/s of outstanding achievements, if any (attested photocopy)
vi) Assessment Certificate of Special Needs / Disability (if applicable)
vii) Photocopy of ID proof of both parents (Aadhaar card / voter identity card / passport)
viii) Photocopy of proof of residence (ration card / voter identity card / residence lease deed / any other)
ix) Registration Fee of Rs. 1000/- in cash or DD, favouring Delhi Public School, Sushant Lok, Gurgaon
payable at Gurgaon (payment for registration to be done in the school). An additional Rs. 100/- to be paid
in case the registration form is downloaded / sent by post.
x) Immunization record of child (to be submitted along with admission form).

DECLARATION :
i) I certify that I am a bonafide parent/guardian of the child.
ii) I understand that rendering false or misleading information or withholding correct information may disqualify
or lead to cancellation of admission /continuation of the child in this school.
iii) I understand that school transport will be provided on the specified routes/stops only (subject to availability)
iv) I fully understand that registration is not a guarantee for admission. Admission is granted only when there is
an existing vacancy and the child's performance in the test is satisfactory as per school norms.
v) I understand that the registration fee of Rs.1000/- is non-refundable.
vi) I have made careful note of various details regarding the payment of school fees. I have made satisfactory
arrangements for the remittance of school fees within due dates without waiting for reminder from the school.
I will pay the school fee through crossed Cheques / Drafts in favour of Delhi Public School, Sushant Lok.
vii) I understand that the fees is subject to upward revision as per the decision of the management.
viii) I understand that since admission is granted to my ward before the start of the academic session, I would
have to pay the difference in the amount in case the fee for the session for which she/he is granted admission
is revised.
ix) I understand that request for withdrawal/ cancellation of admission will be considered only if given in writing
on the prescribed form (available on the school website/admission department) before the session begins
and only the Caution Money will be refunded by the school.
x) I hereby certify that the date of birth & spelling of the name of my child / ward given in this form are
correct and I shall not make a request for any change.
xi) I hereby certify that in case I do not claim the Caution Money within a period of one year of withdrawal/
cancellation of admission, I will have to forfeit my right over the refund of this amount.
xii) Having carefully read the rules, regulations and procedures as mentioned above, and being desirous of
having my child educated in Delhi Public School, Sushant Lok, Gurgaon, I hereby agree to abide by these
rules in all respects. I understand that the decision of the Management of the school shall be final and binding.
xiii) I hereby certify that I shall follow all the rules, regulations & procedures laid down by the school from time to
time.
xiv) I hereby attest my signature to confirm the above declarations.

Date .......................................... Signature ..................................................................................

Place ........................................
Name in Full (Block Letters) .....................................................
.................................................................................................
Address ....................................................................................
.................................................................................................
.................................................................................................
 DELHI PUBLIC SCHOOL
B-Block, Sushant Lok, Phase-1, Gurgaon - 122002
Fax: 0124-4041331 Tel: 0124-4041221, 4041441
e-mail : info@dpssl.net www.dpssl.net